Pavement Restoration 2019

MEDICAL CONTRIBUTION SCHEDULE

Option 1 Choice BJ77

Employee Pays (Weekly)

Employee Only

$ 36.51 $ 153.69 $ 107.83 $ 216.52

Employee + Spouse Employee + Child(ren)

Family

Option 2 Choice AQQ4

Employee Pays (Weekly)

Employee Only

$ 46.07 $176.44 $125.42 $246.34

Employee + Spouse Employee + Child(ren)

Family

Option 3 Choice AQOB

Employee Pays (Weekly)

Employee Only

$ 75.99 $247.65 $180.48 $339.70

Employee + Spouse Employee + Child(ren)

Family

4

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